June 8, 2009

Most Common Cause Of Bankruptcy Is Catastrophic Medical Bills

Why I drink.

Here is the simple reason while there will never be any kind of serious healthcare reform in this country absent a war: no one cares.  About healthcare itself-- it's just a proxy for ideology.   Everything you hear are lies, damned lies, and Harvard.

WASHINGTON (Reuters) - Medical bills are behind more than 60 percent of U.S. personal bankruptcies, U.S. researchers reported on Thursday in a report they said demonstrates that healthcare reform is on the wrong track.

I'm puzzled by the term "U.S. researchers."  They are Harvard academic researchers funded by the Robert Wood Johnson Foundation.  Is this to distinguish them from "French researchers" who presumably have more/less credibility depending on your politics; or is it a slip of the tongue suggesting they are actually working for the U.S. government?

...Harvard's Dr. David Himmelstein, an advocate for a single-payer health insurance program for the United States...

What do the authors want to be.... oh, never mind.

II. 

60% is a big number.   Wow.  I didn't realize it was so high!   What I need now is a striking  metaphor that will move me solidly towards populism:

"Unless you're Warren Buffett, your family is just one serious illness away from bankruptcy."
Nice.  Sounds a lot like

"Unless you're Bill Gates you're just one serious illness away from bankruptcy."







Comments

<a href="http://www.cato.or... (Below threshold)

June 8, 2009 6:48 PM | Posted by Abe: | Reply

http://www.cato.org/event.php?eventid=6169

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..Dissecting medical fro... (Below threshold)

June 8, 2009 8:49 PM | Posted by Jack Coupal: | Reply

..Dissecting medical from other causes of bankruptcy is difficult.

No.

Subtracting 3 from 100 is difficult.

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Clearly I'm stupid, but I'm... (Below threshold)

June 8, 2009 9:05 PM | Posted by Brett: | Reply

Clearly I'm stupid, but I'm having trouble reconciling:

"I'm for the same thing he is for, a single payer system (with modifications)"

with

"universal healthcare is the wrong solution"

Could you elucidate?

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"Could you elucidate?"... (Below threshold)

June 8, 2009 9:13 PM | Posted by joe: | Reply

"Could you elucidate?"

"In 1591 Pope Gregory XIV fell gravely ill. His doctors prescribed pulverized gold and gems. According to legend, the resulting depletion of the papal treasury is reflected in his unadorned plaster sarcophagus in St. Peter's Basilica. Four centuries later, solidly middle-class Americans still face impoverishment following a serious illness."

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(i accidently pushed post c... (Below threshold)

June 8, 2009 9:15 PM | Posted, in reply to joe's comment, by joe: | Reply

(i accidently pushed post comment to early)

thats an example that can be used against universal health care.

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Even if 60% is an inflated ... (Below threshold)

June 8, 2009 9:49 PM | Posted by Jude: | Reply

Even if 60% is an inflated figure, in a country with as many vast resources as the U.S., the fact that anybody goes bankrupt because of medical bills is a crying shame.

Glad I live in Canada.

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We're also the fattest coun... (Below threshold)

June 9, 2009 12:30 AM | Posted, in reply to Jude's comment, by Colin: | Reply

We're also the fattest country and have the highest rates of cancer and heart disease. If half the people just went on a fucking diet we'd save the healthcare system.

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Actually, I believe we in A... (Below threshold)

June 9, 2009 2:15 AM | Posted, in reply to Colin's comment, by Pete: | Reply

Actually, I believe we in Australia may have overtaken the US as the most obese country, Aussie Aussie Aussie!!

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A couple weeks ago in the N... (Below threshold)

June 9, 2009 3:56 AM | Posted by EH: | Reply

A couple weeks ago in the New Yorker there was a good article about some podunk town in Alabamy that leads the nation in per-capita medical spending.

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Meh, I wonder about the >50... (Below threshold)

June 9, 2009 10:18 AM | Posted by Anonymous: | Reply

Meh, I wonder about the >5000 figure.

I don't imagine there's many bills for $5001 in that.

I wonder if there's a tendency for medical bills >$5000 to be 10 or 100X that?

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"A couple weeks ago in the ... (Below threshold)

June 9, 2009 12:35 PM | Posted by medsvstherapy: | Reply

"A couple weeks ago in the New Yorker there was a good article about some podunk town in Alabamy that leads the nation in per-capita medical spending."
Texas. McAllen, Tx.

--I have looked at this whole financial picture the past 2 years - mainly because of these various claims about people not being able to afford health care. Two years ago I lectured that the vast middle class was spending more than they were earning, and choosing to forego the responsible act of maintaining insurance against the most likely financial catastrophe on their horizon: a medical problem requiring several thousand dollars of care.

Basically, most families have a car loan - a nearly completely unnecessary encumbrance of your money. Most families pay at least 100/month, and usually more, in media that is totally unnecessary: cable-plus-netflix-plus-texting, etc. Then, they go out to the movie$, and rent movie$. And buy video games. All for entertainment. Add it up. Typically a couple hundred a month easy.

And health ins costs approx $1,000/month.

"We" have chosen entertainment and a status car over health ins.

"We" do not have budgets by which we live. "We" do not have savings. "We" on average have a few thousand on credit cards, and no specific plan to get that down to zero.

The house of cards has fallen, and now "frugal" is the new "black" (not my words, but I have no idea where I heard it). But it is too late for these bankrupt people.

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What percentage of people w... (Below threshold)

June 9, 2009 1:54 PM | Posted by Tomcatshanger: | Reply

What percentage of people whom die in Canada or England or other socialized medicine meca's would rather go bankrupt and live?

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What logorrhea. All based ... (Below threshold)

June 9, 2009 1:59 PM | Posted by David Johnson: | Reply

What logorrhea. All based on a newspaper article that excited your anti-universal health care beliefs. You waste an entire post talking about something other than the lede, simply because it gives you the opportunity to rail against any other POV. Nice use of irrelevant reasoning.

You also perfunctorily dismiss the study based on the fact it was headed by a doctor who is an advocate for single payer health systems. Tell me, doc, all those studies and think tanks which argue against this approach ... are they somehow more ... objective? Of course not. Please automatically dismiss every study ever done, by anyone, because everyone has a POV. doG forbid we should base our own evaluation on the ACTUAL MERITS of a specific study or experiment. Of course, as you've admitted, you have absolutely no specific information on the actual study. But hey, let's not cloud the issue with facts we don't have. Ungrounded opinions are ever so much more fun.

You might want to wait for the data. Not as interesting, I know. But you might sound like you actually have an argument if you actually had some facts. And I'm not talking about what somebody said 4 years ago.

As an aside, why do all these other industrialized countries have universal health care? You do realize ... that 60% of this country's citizens think it's a damn good idea and that 57% of the population would pay higher taxes to see this come to pass? You do realize the majority of the population ranks health care the number two concern, just behind the state of the economy? You do realize that having an imperfect universal health care system as opposed to no health care coverage means nothing to over 50 million americans?

For the folks who don't feel so sorry for corporate health care inc., check out http://www.pnhp.org/. It's another face on this issue.

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If one were so inclined, th... (Below threshold)

June 9, 2009 2:32 PM | Posted by David Johnson: | Reply

If one were so inclined, they could take 11 seconds and google the actual report: http://pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf. I know, I know ... 11 seconds is almost a lifetime in this busy society of ours.

Turns out there's reasons why loss of work is included in these kinds of studies. Turns out the study talks about medical issues being "linked to" or "propelling" folks into bankruptcy- not being the sole cause.

Here are some excerpts for folks interested in actual facts about the study:

How did medical problems propel so many middle-class, insured Americans toward bankruptcy? For 92% of the medically bankrupt, high medical bills directly contributed to their bankruptcy. Many families with continuous coverage found themselves under-insured, responsible for thousands of dollars in out-of-pocket costs. Others had private coverage but lost it when they became too sick to work. Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year. Income loss due to illness also was common, but nearly always coupled with high medical bills.

Oh, now I get why they included illness. It's significant, because half of the insured lost their coverage when they lost their jobs. How did LP characterize it? Oh yeah, because of a loss of income. Funny how people can summarize, isn't it?

Here's another:

Hospital bills were the largest single out-of-pocket expense for 48.0% of patients, prescription drugs for 18.6%, doctors’ bills for 15.1%, and premiums for 4.1%. The remainder cited expenses such as medical equipment and nursing homes.

Out-of-pocket medical costs averaged $17,943 for all medically bankrupt families: $26,971 for uninsured patients, $17,749 for those with private insurance at the outset, $14,633 for those with Medicaid, $12,021 for those with Medicare, and $6545 for those with Veterans Affairs/military coverage. For patients who initially had private coverage but lost it, the family’s out-of-pocket expenses averaged $22,568.

Ah yes, those pesky "out of pocket" expenses. Stupid of people to rely solely on health insurance they pay or co-pay into year after year.

Again, let me save you the 11 seconds of effort involved to find the the actual, goddamn report: http://pnhp.org/new_bankruptcy_study/Bankruptcy-2009.pdf

Let the cherry picking begin ...

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No, nobody does care. It's ... (Below threshold)

June 9, 2009 3:33 PM | Posted by Aurelia Masterson: | Reply

No, nobody does care. It's not real to them--they can't quite seem to make the emotional connection. The insurance companies are outright evil the way they calculate human life. It's just their own vision of the world and they will not let any evidence get in the way of that. This may be a personal thing, but, the guy is a professor from Harvard. When I think "people in touch with reality" I do not think any of them have stepped foot in that institution.

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Slow down, Captain Ameri... (Below threshold)

June 9, 2009 10:48 PM | Posted, in reply to David Johnson's comment, by Alone: | Reply

Slow down, Captain America, I'm on your side. I didn't have the study; now I do.

The 92% figure above is, unfortunately, completely bogus. I don't deny that medical bills contributed, but it's not the same as causing the bankruptcy. (e.g. why didn't they call it a credit card bankruptcy?)

(Fortunately for me and this post) the 2009 study is really making a case for disability insurance, not universal healthcare:

1. "Less than a quarter were uninsured when they filed for bankruptcy." That's the point. Universal coverage would not have helped the 75% who were.

2. "Medical impoverishment is almost unheard of in wealthy countries other than the U.S. Most provide a stronger safety net of disability income support."

3. "Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness..." First of all, that's not even legal. The companies in question are usually bankruptcies or takeovers. Second, the reference the authors used to support that statement said, specifically, "[companies] dismiss employees as soon as they go on long-term disability and that 24% dismiss them at a set time thereafter, usually six to 12 months." Again, it's disability insurance that's at issue here, not medical coverage.

4. The passage you quote ("Hospital bills were the largest single out-of-pocket expense...") is also misleading. Hospital bills weren't the largest _debt_ owed by those who filed bankruptcies; it was the largest expense of all of their medical expenses-- which isn't that surprising, obviously. Especially when you consider that those "hospital bills" include ER visits because they weren't using their primary care doc. But the fact that a diabetic had $25k in expenses doesn't mean all of their other bills (house, cars) were paid in full.

Look, I'm not an idiot: I realize healthcare coverage is expensive. That's why I'm for a single payer system. But the point of the post is that the study makes a case for better disability insurance, not universal healthcare; but that the authors have decided to make it about healthcare, because that's what he wants to talk about.

Listen to him speak if you don't believe me: nothing about cutting costs at all, except the silly nonsense about reducing bureaucracy. Really? Is that the big expense? Nothing at all about reducing payments to doctors, or reducing the use of tests and procedures, the things that actually cost money.

Finally, along the lines of "why I drink:" the text of his speech is below the video (linked above.) Generally a dry speech, but at paragraph 4, he couldn't help adding one line that wasn't in his prepared text: "...they don't pay their CEO $225,000 a day, as Aetna's CEO received." Go populism.

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Bee up your bonnet there Da... (Below threshold)

June 9, 2009 10:59 PM | Posted, in reply to David Johnson's comment, by Anonymous: | Reply

Bee up your bonnet there David?

People are for everything until the true cost is at their doorstop.

But let's just take a look at all of those great health care systems which employ socialized medicine. Sure, they cover everyone, but what is the QUALITY of care they provide?

Are you seriously going to tell me that if you or someone you loved was diagnosed with, say, cancer, you would be heading to the border?

No you wouldn't. You know as everyone else does in their heart of hearts that when it comes to quality, socialized medicine can't shake a stick with what we have here in the U.S.

Anyone who believes that we can have gold plate health care for everyone is one of those types who thinks they can have their cake and eat it too.

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Girlfriend sprained her ank... (Below threshold)

June 10, 2009 1:33 AM | Posted by crumbskull: | Reply

Girlfriend sprained her ankle a few weeks ago at the tidepools. Spent the morning in a free clinic, woman looked at it for ten seconds, gave us a requisition for an x-ray at General and an appointment to come back in two days.

Spent the afternoon at general waiting for the x-ray, they told us it was fractured and to go the E.R. right away, they put her on a stretcher and wheeled her there, she got rushed to the head of the triage line because she was white and sincere looking.

Spent the evening in the hallway of the E.R. triage place with shot guys wheeling past us, got wheeled into a different hallway outside the door of a room with a manacled convict in it who kept complaining about being hungry. Eventually a guy walked up to us and told us it wasn't broken, the x-ray had been misread. Gave her a splint and two vicodin and sent us on our way.

This morning she got a bill for 1800.

It is what it is I guess.

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I'm curious,what's t... (Below threshold)

June 10, 2009 1:42 AM | Posted by mike: | Reply

I'm curious,
what's the most common cause of bankruptcy in countries that do have universal healthcare?

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I reddited this story:... (Below threshold) "Even if 60% is an inflated... (Below threshold)

June 10, 2009 2:26 AM | Posted, in reply to Jude's comment, by Anonymous: | Reply

"Even if 60% is an inflated figure, in a country with as many vast resources as the U.S., the fact that anybody goes bankrupt because of medical bills is a crying shame."

"Glad I live in Canada."

LOL! Oh God no. We just invent our own excuses.

I'm bipolar. So sue me. :)

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What are smokin', binky, ak... (Below threshold)

June 10, 2009 3:51 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

What are smokin', binky, aka "Mr. Anonymous?" Besides your touching corporate patriotism, is there anything you could add to your post that might back up some of your assertions? You know ... like facts?

First of all, universal health care doesn't necessitate the "death" of private care. You might want to check into Canada for a quick snapshot of how that works. Or not. After Canada, check into at least 20 other countries where it also works.

Secondly, could you please back up your belief that "socialized medicine can't shake a stick with what we have here in the U.S."

What countries that have universal health care are you referring to? Were they Argentina, Brazil, Canada, Chile, Costa Rica, Cuba, Mexico, Panama, Peru, Uruguay, Venezuela, Brazil, Brunei, Hong Kong, India, Kuwait, Qatar, Saudi Arabia, Israel, Japan, Malaysia, South Korea, Seychelles, Sri Lanka, Taiwan, Pakistan, Thailand, Austria, Belgium, Bosnia & Herzegovina, Bulgaria, Croatia, the Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, the Netherlands, Norway, Portugal, Poland, Romania, Russia, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Ukraine or the United Kingdom or some others?

Everybody says the US has the finest medical facilities, the best doctors, etc. It does. For the top economic tier of this country. The rest of us put up with mediocre health care coverage at costs higher than any other industrialized nation, or none at all. Are you seriously proposing to argue that NO health care for 50 million americans is better than some goldarned socialized medicine? Good luck on that one.

But what I'm really starved for is a few facts from fatuous posters like yourself. God bless america.

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Universal health care sure ... (Below threshold)

June 10, 2009 10:36 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

Universal health care sure does mean the death of private health care because it creates an unfair market whereby the governmental sets the price for its subsidized services that private insurers cannot compete with. Besides, who (employer or self-employed) person would opt for pricey private insurance when public insurance is "free".

I'd say that the US beats all of those countries you listed. Like I said, if you are diagnosed with cancer are you seriously going to run to any of those countries to get your care? But, strangely, lots of people for, say, Canada, come to the US for care despite the glory of their universal care system.

Now when you say that 50 million people don't get health care in the US... well you're full of it. Just because these middle class folks don't have insurance doesn't mean they go without care. That's illegal and I've never seen it happen (yes, I would know).

The real question is one of cost. Poor people have Medicaid, most everyone else has private insurance. Fifty million ELECT to forgo insurance because it's expensive. Like how a car can be expensive. Yet if we believe that everyone is entitled to the same level of care, then it's going to be expensive by definition. It all depends then on what we all what to spend our money on (or whether we really believe everyone is entitled to the same care).

Now I realize, comrade, that because I'm defending private insurance that makes me some sort of evil, corporate-loving, monster. But maybe, just maybe, the grass always looks greener...

I also could comment about how YOU provide no facts or citations but the truth is this isn't a debate that requires empirical notes. It's just common sense that there's no free lunch in this world no matter where you live.

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For people in the majority ... (Below threshold)

June 11, 2009 7:12 AM | Posted by Sabremesh: | Reply

For people in the majority of developed countries, your arguments about the cost of universal healthcare seem slightly hysterical. But more to the point, they are completely irrelevant.

This is because most people outside the US believe that a civilized society is one in which the vulnerable (young, old, sick, poor) have the same fundamental human rights as everybody else. By this I mean they are guaranteed access to (or assistance with) shelter, food & water, education, healthcare, political & legal representation.

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Do you by virtue of nothing... (Below threshold)

June 11, 2009 3:56 PM | Posted by Anonymous: | Reply

Do you by virtue of nothing other than having been born human really have a legitimate claim to the right to be fed, clothed and sheltered by other humans?

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Are you seriously going ... (Below threshold)

June 11, 2009 9:48 PM | Posted, in reply to Anonymous's comment, by Jane: | Reply

Are you seriously going to tell me that if you or someone you loved was diagnosed with, say, cancer, you would be heading to the border?

Are you seriously saying you don't have friends and loved ones who have done exactly that?

I am so tired of hearing this crap. Best medical care in the world! And if you can't afford, f*ck you, I can!

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I don't know anyone who's e... (Below threshold)

June 11, 2009 11:10 PM | Posted, in reply to Jane's comment, by Anonymous: | Reply

I don't know anyone who's exited the US to receive heath care somewhere else. I've never heard of anyone doing such a think and I work in the health care field.

Jane, nothing in life is free. That is basic lesson of life that even a child understands.

I'm sick of people thinking that they are entitled to top notch health care without having to pay for it. I mean, what planet are you living on, anyways?

Stuff costs money and that includes health care. All of those life saving procedures cost something. Indeed, it costs a lot. But if your naive enough to think that if the government pays for it than it's free, well, our country is more screwed up than I thought.

And if you seriously believe that the quality of care is better in Europe, than we're completely screwed.

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Folks don't even need to lo... (Below threshold)

June 15, 2009 4:34 PM | Posted by Jen: | Reply

Folks don't even need to look to Europe or Canada for an example of What Happens When the Government Gives You Health Coverage. Just ask a vet!

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There needs to be a law mak... (Below threshold)

June 26, 2009 1:53 PM | Posted by david: | Reply

There needs to be a law making health insurance mandatory the same as auto insurance. Without an employer or gov't sponsored plan, Americans will not pay their bills period. As a nation we consume we do not save, we are upside down in mortgage and other debt. We have uninsured people who choose to spend hundreds of dollars each month on cigarettes, fast food, phone service, cable, and then claim they have no money for health coverage...why should the governement (our tax money) support a poorly budgeted lifestyle. Reform the system to bring prices down to reality, but make people pay individually.

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I agree that no American sh... (Below threshold)

June 26, 2009 5:52 PM | Posted by moia: | Reply

I agree that no American should be allowed access to any health care without paying for it, up front just like in China.
I believe Americans have yet to evolve enough to be allowed to access any system that demonstrates that they actually give a sh%t about your neighbour you good christians you...
Keep your present system. I think it works great and you deserve the system you have, it's just so "love thy neighbour" but don't even think about letting that unemployed possible immigrant bastard access the kind of health care YOU get because YOU pay for it. He is allowed the free clinic with an appointment in six months and ER treatment only if he is near death. Seems fair and just what Jesus would do right America?

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1. air jordan shoes, it is!... (Below threshold)

December 16, 2009 2:20 PM | Posted by medsvstherapy: | Reply

1. air jordan shoes, it is! FTS!
2. leaving the U.S. for care: yes - medical tourism - medical practitioners have been padding bills to such a degree, and the collab between providers and insurers, --leaving the third party --the insured --out of the deal -- has gotten so bad that I will be offered treatment overseas. What will it take to convince me that the surgery ceter overseas is decent? Get ready for this: 1. quality through and through - no free gift of c difficil, etc., and 2 get this - payment tied to outcomes. Quality and performance-based pay. And not pay for asking me if I smoke or have gotten a mammogram in the past year. Pay for my ejection fraction getting to standard post-CABG. Goodnight, doctor. Alternative - open the doors to the foreign docs, who will not be eager to join AMA as locals seem to be.

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There is a failure to imagi... (Below threshold)

December 17, 2009 1:52 PM | Posted by Bob Watson: | Reply

There is a failure to imagine circumstances here. A person may lose employment income for more reasons than a medical disability. Getting fired, getting laid off, or, most importantly, quitting to care for a family member, say a child with cancer. Disability insurance does not pay in any of these circumstances. Quitting to provide care to a family member, says Elizabeth Warren, is commonly the way medical matters cause bankruptcy.

-----

No one knows more about the circumstances of bankruptcy in the US than Elizabeth Warren, Harvard Law professor and author of The Two Income Trap. If you would actually like to know something about personal bankruptcy in the US--instead of what you think you know about it-- this is a lecture she gave at Berkeley.
http://www.uctv.tv/search-details.aspx?showID=12620

It's an hour long, so here's some details. The demographic she studies is middleclass husband/wife/two kids and the economic circumstances of such families in the early 1970s compared to now. This is the demographic of Norman Rockwell America; if things are going poorly for them, then woe betide.

In this demographic, bankruptcy is twice as common as divorce. Read that again.

Back then, hw2k had one breadwinner, now it's two. Much more income, so how come there's an economic problem? EW shows convincingly that such families do NOT spend more of their income now than they did then on consumer electronics or eating out or clothing or furniture or vacations or other categories where they are accused of self-indulgence.

Where is the financial squeeze for the two income family? Taxes, for one. They are in a higher bracket. Two jobs means two cars. Day care for the kids. Same size house as the 70s costs twice as much after adjusting for inflation. Higher payroll deduction and copays than employer health insurance cost back then.

-----

In the US we already pay 16% of GDP for health care. In Europe, Canada, Japan, Australia, that is the industrialized nations of the world, they average between 8 and 10% of GDP. What do we get for double the cost? The lowest life expectancy and the worst infant mortality.

We have superb trauma care here; no better place to be if you are smashed up, shot, or burned, but our cancer care is no better than the other developed nations.

The hospitals, drug companies, med equipment makers, insurance companies and doctors here in the US all seem to believe they are absolutely entitled to 8%+ compounded growth in their earnings in perpetuity

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we come according to Harvar... (Below threshold)

October 14, 2010 3:06 AM | Posted by mikean: | Reply

we come according to Harvard’s law and medical schools said the findings underscore the inadequacy of many private insurance plans that offer worst-case catastrophic coverage, but little financial security for less severe illnesses.

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It looks like we are going ... (Below threshold)

November 18, 2010 2:56 PM | Posted by David Dzidzikashvili: | Reply

It looks like we are going to have a negative economic domino effect all over Eurozone… At first Greece, then Ireland… Who is next? Portugal or Spain or…? I think the political support for bail outs is vanishing as well as Germans for example would at some point get fed up and stop carrying other countries on their backs…

It’s clear that the government of Ireland misjudged its crisis early on even ignored the vital signs… Another example of government failure, excess spending addiction that resulted in economic collapse… This trend is noticeable everywhere (at different levels) across the EU… Ireland’s national 2010 deficit will climb to a staggering 32% percent of GDP!!! This is a recipe for a (future) disaster!

What’s next for Ireland? More cuts? And who is going to be the next for IMF and EU bailout list?

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The biggest problem in heal... (Below threshold)

December 18, 2013 8:19 AM | Posted, in reply to Colin's comment, by Anonymous: | Reply

The biggest problem in healthcare is not fat people. Thin people have heart attacks too. The problem is very simple and that is obscene costs of healthcare that should be capped at a reasonable amount. $8000 for a fifteen minute stay at an ER is not uncommon in this greedy country.

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